Radiation Oncology | |
Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis | |
Riccardo Maurizi Enrici2  Andrea Romano1  Alessandro Bozzao1  Guido Trasimeni1  Mattia Falchetto Osti2  Gaetano Lanzetta3  Enrico Clarke2  Giuseppe Minniti3  | |
[1] Department of Neuroradiology, Sant' Andrea Hospital, University "La Sapienza", Rome, Italy;Department of Radiation Oncology, Sant' Andrea Hospital, University "La Sapienza", Rome, Italy;Department of Neurological Sciences, Neuromed Institute, Pozzilli (IS), Italy | |
关键词: brain necrosis; radiation-induced complications; survival; stereotactic radiosurgery; brain metastases; | |
Others : 1224394 DOI : 10.1186/1748-717X-6-48 |
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received in 2011-02-02, accepted in 2011-05-15, 发布年份 2011 | |
【 摘 要 】
Purpose
to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis.
Patients and Methods
Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications.
Results
Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm3 and V12 Gy >10.9 cm3 the risk of radionecrosis was 47%.
Conclusions
SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm3 carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.
【 授权许可】
2011 Minniti et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20150909115138827.pdf | 248KB | download | |
Figure 2. | 22KB | Image | download |
Figure 1. | 25KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
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